Provider Demographics
NPI:1588761431
Name:DRAKE, THOMAS C I (PA-C)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:C
Last Name:DRAKE
Suffix:I
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5851 TIMUQUANA RD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-7878
Mailing Address - Country:US
Mailing Address - Phone:904-317-5069
Mailing Address - Fax:904-778-6440
Practice Address - Street 1:5851 TIMUQUANA RD
Practice Address - Street 2:SUITE 401
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-7878
Practice Address - Country:US
Practice Address - Phone:904-317-5069
Practice Address - Fax:904-778-6440
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100914363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE3577XMedicare ID - Type Unspecified
FLS98264Medicare UPIN